Ultrasound Diagnosed Rare Partial Nephrectomy Complication

Abstract

Renal artery pseudoaneurysm (RAP) is a serious complication that can lead to severe hematuria, blood loss, and life-threatening hemorrhagic shock. A pseudoaneurysm is defined as an arterial wall deficiency that results in the accumulation of oxygenated blood in the nearby extraluminal region. Partial nephrectomy, a parenchymal sparing method, carries a lower risk of postoperative development of chronic kidney disease than total nephrectomy but a higher risk of iatrogenic vascular lesions such as RAP or arteriovenous fistulas. Pseudoaneursyms may develop secondary to arterial transection during tumor resection or due to arterial puncture during suture ligation of the resection bed. Emergency transarterial embolization is an effective treatment modality for patients with hemodynamic instability that does not lead to significant worsening of renal function. The recent literature reports an incidence of 2.7 to 21.7% of RAP or arteriovenous fistulas after partial nephrectomy. We report a case of severe bleeding with massive hematuria due to RAP, which was detected with duplex sonography.

Keywords

partial nephrectomy - renal artery pseudoaneurysm - duplex sonography - “to-and-fro” waveform - acute renal injury - coiling - postoperative complications

• References

• 1 Jain S, Nyirenda T, Yates J, Munver R. Incidence of renal artery pseudoaneurysm following open and minimally invasive partial nephrectomy: a systematic review and comparative analysis. J Urol 2013; 189 (05) 1643-1648
• 2 Hyams ES, Pierorazio P, Proteek O. , et al. Iatrogenic vascular lesions after minimally invasive partial nephrectomy: a multi-institutional study of clinical and renal functional outcomes. Urology 2011; 78 (04) 820-826
• 3 Kriegsmair M, Mandel P, Rathmann N, Diehl S, Pfalzgraf D, Ritter M. Open partial nephrectomy for high-risk renal masses is associated with renal pseudoaneurysms: assessment of a severe procedure-related complication. BioMed Res Int 2015; Article ID 981251, 7 pages
• 4 Strobl FF, D'Anastasi M, Hinzpeter R. , et al. Renal pseudoaneurysms and arteriovenous fistulas as a complication of nephron-sparing partial nephrectomy: technical and functional outcomes of patients treated with selective microcoil embolization during a ten-year period. RoFo Fortschr Geb Rontgenstr Nuklearmed 2016; 188 (02) 188-194
• 5 Stephenson AJ, Hakimi AA, Snyder ME, Russo P. Complications of radical and partial nephrectomy in a large contemporary cohort. J Urol 2004; 171 (01) 130-134
• 6 Sam K, Gahide G, Soulez G. , et al. Percutaneous embolization of iatrogenic arterial kidney injuries: safety, efficacy, and impact on blood pressure and renal function. J Vasc Interv Radiol 2011; 22 (11) 1563-1568
• 7 Mahmoud MZ, Al-Saadi M, Abuderman A. , et al. “To-and-fro” waveform in the diagnosis of arterial pseudoaneurysms. World J Radiol 2015; 7 (05) 89-99
• 8 Omae K, Kondo T, Takagi T. , et al. Renal sinus exposure as an independent factor predicting asymptomatic unruptured pseudoaneurysm formation detected in the early postoperative period after minimally invasive partial nephrectomy. Int J Urol 2015; 22 (04) 356-361
• 9 Gupta N, Patel A, Ensor J. , et al. Multiple renal artery pseudoaneurysms in patients undergoing renal artery embolization following partial nephrectomy: correlation with RENAL nephrometry scores. Cardiovasc Intervent Radiol 2017; 40 (02) 202-209